THE INFLUENCE OF THE ANESTHETIC TECHNIQUE ON BLOOD-LOSS DURING REDUCTION MAMMAPLASTIES - A STUDY ON 56 PATIENTS OPERATED ON BY A SINGLE SURGEON

Since we had the impression that there was an increase in blood loss d uring mammaplasties after a change in the anesthesiology department re sponsible, we conducted a study to compare 28 cases from each anesthes iology department. All operations were carried out by the first author in succession using the same operative technique. The two groups did not differ In age, BMI, operative time, weight of resected tissue or p reoperative laboratory. Blood loss was calculated from the perioperati ve drop in hemoglobin and patient's blood volume. Blood pressure, hear t rate, medication and intravenous fluid supply were obtained from the anesthetic protocols. Results (means and standard deviations): Group I (n = 28) and [Group II (n = 28)]: total resected tissue 1862 +/- 928 g [1912 +/- 791 g]; Hb-preop. 13.6 +/- 0.9 g/dl [13.8 +/- 0.8 g/dl]; Hb-postop. 10.8 +/- 1.3 g/dl [9.7 +/- 1.3 g/dl] P = 0.006 Blood loss 9 70 +/- 339 ml [1443 +/- 456 ml] P < 0.001. After exclusion of surgical or biological causes hemodynamic effects of the anesthetic techniques were suspected as the reason for the significant difference in blood loss. MAP was elevated only initially, while the heart rate was consid erably elevated throughout the procedures in group II. During anesthes ia with nitrous oxide and enflurane, the dose of enflurane in group I could be limited to 0.3-0.5 % after initial i.v. administration of 60 to 100 mu g sufentanil, while in group II without opioids doses of 0.5 -2 % were required. The well-known dose-dependend effect of enflurane on the peripheral vascular tone was not masked by vasoconstrictors at the operative site. Conclusions: Blood loss during mammaplasties can b e affected considerably by the anaesthetic technique even without deli berate hypotension. Sufentanil can indirectly reduce the blood loss by lowering the necessary dose of enflurane. Blood transfusions can be a voided at mammaplasties.